ALICE test

ALICE test — hidden infections in the endometrium that can prevent pregnancy

ALICE (Analysis of Infectious Chronic Endometritis) is a modern molecular test that detects the presence of chronic endometritis - a hidden inflammation of the uterine lining caused by microorganisms. This condition often proceeds without symptoms, but can seriously affect the implantation of an embryo and the successful development of pregnancy.

What is chronic endometritis?

Chronic endometritis is a persistent inflammation of the endometrium, in which the immune system responds to the presence of pathogenic bacteria without having an acute infection. In this condition, the lining of the uterus may look normal on ultrasound or hysteroscopy, but its internal environment is not optimal for implantation and pregnancy retention.

The most common causes of endometritis

• Sexually transmitted infections — chlamydia, gonorrhea;
• Tuberculosis — tuberculous mycobacteria reach the uterus by blood, with the primary focus most often in the lung;
• Infections arising from the normal vaginal flora that has reached the uterus in an ascending way;
• Intestinal bacteria that got into the genitals. Independent studies have shown that this disease affects up to 30% of patients with infertility, up to 66% of patients with repeated unsuccessful embryo implantation, as well as in cases of multiple miscarriages.

How does the ALICE test detect the problem?

ALICE uses molecular technology (qPCR) to detect pathogenic bacteria associated with chronic endometritis. The test identifies the presence and amount of bacteria such as:

• Escherichia coli
• Enterococcus faecalis
• Streptococcus spp.
• Mycoplasma spp.
• Ureaplasma spp.
• Gardnerella vaginalis
• And other opportunistic microorganisms

The test is much more sensitive than classical microbiological cultures and gives a result even in the presence of bacteria in very low concentrations.

When is the ALICE test recommended?

ALICE is especially appreciated in:

• Repeated unsuccessful embryo transfers;
• Early miscarriages;
• Suspicions of inflammatory processes without a clear clinical manifestation;
• Before first transfer in women with risk factors or operational history.

How is it carried out?

1. Endometrial biopsy — a small piece of the lining of the uterus is taken on a specific day of the cycle (often combined with tests such as ERA/EMMA).
2. Molecular analysis — DNA analysis is performed in the laboratory by qPCR.
3. Individual report — you get an accurate list of detected bacteria and their concentration.

What happens after a positive result?

If ALICE detects the presence of bacteria, specific antibiotic treatment is prescribed based on the type and concentration of microorganisms. After completion of therapy, a repeat test is often recommended to confirm the clearance of the infection and the readiness of the endometrium for implantation.

What do we offer in our clinic?

In Vitro Clinic “Sofia” we apply the ALICE test to women with repeated failures or suspected chronic endometritis. We provide a comprehensive approach — from precise biopsy to individual treatment plan, follow-up and re-evaluation as needed.

Conclusion

Chronic endometritis often goes unnoticed, but it can be a serious obstacle to successful implantation and pregnancy. The ALICE test detects the problem in time and allows effective treatment so that the uterus is fully prepared for the welcome of a new life.

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